Heel pain

Heel pain is a frequently observed deformity which commonly affects individuals who are active in sport, overweight/obese or have structural anomalies such as high arches or flat feet. Heel pain involves the plantar fascia and musculature at its insertion at the heel. Heel pain may progress from acute to chronic depending on the duration and severity of symptoms

Symptoms of heel pain may be broken down as follows:

  • Insertional fasciitis at the medial calcaneal tubercle. Heel pain is typical upon rising in the morning [post static dyskinesia]
  • Concomitant restriction of the Achilles tendon and excessive tightening of the plantar fascia upon dorsiflexion of the 1st metatarsal or ‘great toe joint’ [windlass mechanism]
  • Reproducible symptoms upon range of motion of the 1st metatarso-phalangeal joint
  • Heel spur formation evident on a lateral radiograph

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Causes

Causative factors include: Micro or macro trauma leading to fascia tear and sub-sequential inflammation, genetic predisposition to structural foot anomalies, local and systemic musculoskeletal diseases such as rheumatoid arthritis leading to altered foot structure, ill-fitting footwear and obesity.

Diagnosis

Diagnosis is made through clinical assessment although ultrasonography and x-rays may be useful in ascertaining a diagnosis. Clinical assessment involves determining the exact nature of the patient’s symptoms.

Conservative Management

  • Orthotic therapy may be helpful in offloading the painful heel
  • NSAID/steroid therapy to alleviate symptoms associated with inflammation
  • Calf stretching exercise would also be useful for tight Achilles tendons
  • Extra Corporal Shock Wave Therapy [ESWT] has been shown to be an effective alternative for those who do not respond to more conservative therapy

Surgical Management

The aim of surgical intervention is to eliminate pain and restore function. Techniques used include plantar fasciotomy and tarsal tunnel release. Depending on the cause of the heel pain, surgery may involve the removal of bone spurs, removal of scar tissue or the release of nerve compression. This procedure is usually performed under local anaesthetics as Day Surgery.

Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner

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